PREDICTORS OF ADVERSE OUTCOME IN CANCER-PATIENTS WITH CANDIDEMIA

BACKGROUND: Many factors, including severity of illness, neutropenia, intravenous catheter management, and drug therapy may affect the outco me of candidemia in cancer patients. METHODS: The records of all patie nts at M. D. Anderson Cancer Center who developed one or more positive blood cultures for Candida spp between January 1, 1988, and December 31, 1992, were retrospectively reviewed. Four hundred ninety one episo des of candidemia were identified, for which 476 had complete medical records, which were reviewed in detail. RESULTS: By 3-month follow-up, 52% of the patients had died. Neutropenia, higher APACHE III score, a nd visceral dissemination were associated with poor prognosis. Cure ra tes, adjusted for severity of illness, were similar for fluconazole an d amphotericin B treatment. Exchange of central venous catheters was a ssociated with a modest improvement in prognosis. CONCLUSION: Several factors that influence the outcome of candidemia in cancer patients ha ve been identified. These factors may be relevant for the clinical man agement of cancer patients with candidemia, and for the design of ther apeutic trials.